Discordance between the patient’s and physician’s global assessment in rheumatoid arthritis: Data from the REAL study—Brazil

Abstract

Background Discordance between patient's global assessment (PtGA) and physician's global assessment (PhGA) has been described in rheumatoid arthritis (RA). Understanding the reasons for this discrepancy is important in the context of treat-to-target treatment strategy. Objective To assess the determinants of PtGA and PhGA and factors associated with discordance between them. Methods The REAL study included RA patients from Brazilian public health centers. Clinical, laboratory and outcomes measures were collected. PtGA and the PhGA were rated on a visual analog scale and analyzed. Three groups were defined: no discordance (difference between PtGA and PhGA within 3 cm), positive discordance (PtGA exceeding PhGA by >3 cm), and

Pain Mechanism in Rheumatoid Arthritis: From Cytokines to Central Sensitization

“…Even if the pain level is low, it will also restrict the activity [ 7 ]. Moreover, it is also a determinant of the patients' assessment of disease activity [ 8 ]. However, for doctors, the contribution of pain to the overall evaluation of the disease is relatively small, while joint swelling is the most important factor for doctors to evaluate the disease activity [ 8 ].…”

“…Moreover, it is also a determinant of the patients' assessment of disease activity [ 8 ]. However, for doctors, the contribution of pain to the overall evaluation of the disease is relatively small, while joint swelling is the most important factor for doctors to evaluate the disease activity [ 8 ]. Although the treatment of RA has made remarkable progresses in recent years, which has greatly improved the control of disease activity and joint damage, the degree of pain in RA patients included in the 2000s did not alleviate compared with that included in the 1990s over 8 years of follow-up [ 9 ].…”

Analysis of patient-physician discrepancy in global assessment of systemic autoimmune myopathy disease activity

“…The cut-off of 2.0 points difference used to define discordance between patient-physician assessments was chosen taking into consideration published studies on similar topics (14,15,19), including a recent study which analysed patient/family and physician discordance of global disease assessment in juvenile dermatomyositis (15). However, this cut-off of 2.0 points difference is not standardised in the literature, and there are studies in immune-mediated rheumatic diseases that considered other values to define discordance between patient-physician assessments (9,12,22). The majority of the myositis patients in this study rated themselves similarly to their treating physicians, since 72% of the absolute VAS differences regarding global disease activity were below 2.0 cm.…”

Patient Reported Outcomes in Chronic Inflammatory Diseases: Current State, Limitations and Perspectives

“…Many PROs contain one question related to the overall disease activity or the overall health, which can be rated by the patient on a Visual Analogue Scale (as a PaGA) ( 20 ). PaGA correlates moderately with more objective measures of disease activity, but is also influenced by non-rheumatic factors, such as education or the cultural background of a patient ( 5 , 20 ). Because PaGA mostly focus on the disease activity in the form of symptoms and pain at the main organ side (e.g.…”

“…quality of life, fatigue or social functioning and should thus be taken into account in treatment decisions by physicians ( 4 ). Of note, significant patient-physician discordance of disease activity is a frequently reported phenomenon ( 5 , 6 ). This discrepancy may significantly reduce the likelihood of reaching remission in composite-scores used for measurement of disease activity, which complicates the application of treat-to-target approaches ( 7 ).…”